February 05, 2013 "Information
Clearing House"
- The article below is the most comprehensive analysis
available of "Obamacare" – the Patient Protection and
Affordable Care Act. The author, a knowledgeable person who
wishes to remain anonymous, explains how Obamacare works for
the insurance companies but not for you.

Obamacare was formulated on the concept of health care as a
commercial commodity and was cloaked in ideological slogans
such as "shared responsibility," "no free riders" and
"ownership society." These slogans dress the insurance
industry’s raid on public resources in the cloak of a “free
market” health care system.

You will learn how to purchase a subsidized plan at the
Exchange, what will happen when income and family
circumstances change during the year or from one year to the
next, and other perils brought to you by Obamacare. It is
one of the most important articles that will be posted on my
website this year. Americans will be shocked to learn the
extent to which they have been deceived. The legislation
neither protects the patient nor are the plans affordable.

The author shows that for those Americans whose income
places them between 138% and 400% of the Federal Poverty
Level, the out-of-pocket cost for one of the least expensive
(lower coverage) subsidized policies ranges from 2% to 9.5%
of Modified Adjusted Gross Income (MAGI), a tax base larger
than the adjusted Gross Income used for calculating federal
income tax.

What this means is that those Americans with the least or no
disposable income are faced in effect with a substantial pay
cut. The author provides an example of a 35 year-old with a
MAGI of $27,925. The out-of- pocket cost to this person of a
Silver level plan (second least expensive) is $187.33 per
month. This cost is based on pre-tax income, that is, before
income is reduced by payroll and income taxes. There goes
the car payment or utility bill. The lives of millions of
Americans will change drastically as they struggle with a
new, large expense – particularly in an era of no jobs,
low-paying jobs and rising cost of living.

The author also points out that the cost of using the
mandated policies will be prohibitive because of the large
deductibles and co-pays. Many Americans will find themselves
not only with a policy they can't afford, but also with one
they cannot afford to use. Those who cannot afford the
insurance, even with a subsidy, will be faced with a costly
penalty, and in many cases, this, too, will be difficult, if
not impossible, to pay. As each year’s subsidy is based on
last year’s income, there will be a substantial year-end tax
liability for those who must repay the subsidy in whole or
part because their income increased during the year. The
stress alone from such a regressive scheme is, without a
doubt, not conducive to good health and well-being.

Diets will worsen for millions of Americans as they struggle
with a new large expense. Thus, the effect of Obamacare will
be to worsen the health of millions. Indeed, a “glitch” in
the legislation allows millions to be priced out of
coverage.

The demand that Obamacare places on household budgets in
which there is no slack makes me wonder where the
president’s economists were while the insurance lobby
crafted the product that serves the profits of insurance
companies. Two well-known economic facts are that real
family income has been stagnant or declining for a number of
years and Americans are over their heads in debt.

How does Obama preside over a recovery when consumer
purchasing power is redirected to insurance company profits?

Obamacare not only rations health care by what a person or
family can afford, but also has implications for Medicare
patients. Hundreds of billions of dollars are siphoned from
Medicare to help pay the cost of Obamacare. The health care
provided to Medicare patients will decline with the reduced
payments to care providers. Health care seems destined to be
rationed according to the age and illnesses of Medicare
patients. Those judged too old and too ill could be denied
expensive treatments or procedures that would prolong their
lives.

Obama will rue the day that his name was put on this special
interest legislation, and most Americans, once they realize
what has been done to them, will be angry that special
interests again prevailed over the health of the nation.

OBAMACARE:
DEVILS IN THE DETAILS

The Patient Protection and Affordable Care Act of 2010,
commonly referred to as the ACA or Obamacare, will go into
full effect in 2014. This decree mandates that all Americans
must purchase and maintain government-approved health
insurance or pay a penalty to the IRS. Touted as a plan to
provide all Americans with access to medical care, in
reality, this compulsory shakedown commands everyone to
purchase insurance that for many will be too expensive, even
with government subsidies – or unaffordable to use – or
both.

The ACA was not selflessly designed with the intent of
providing affordable and equitable medical services to those
in need, but rather to acquire taxpayer money for the
private insurance companies under the seemingly helpful
guise of health care and the ideological excuse of personal
responsibility. It takes money from ordinary people and
gives it to a medical insurance industry that profits
handsomely from this legally-enforced corporate welfare –
all while keeping Americans locked in the same broken system
that puts profit before patients. The law was essentially
written by business executives from the industry so that
special interests would not be upset and profits assured.

There’s a lot to digest about how the ACA works and much is
buried in a complex, convoluted maze of regulations and
procedures. A few websites contain explanations, but very
important details have either been left out or glossed over.
These details are well worth understanding so you will know
what’s at stake for you and your family. This lesson is not
meant to convey a political opinion. This is how the ACA
works and under this law, there are no sacred cows.

In today’s lesson, you will learn why 2013 is an important
year for many of you with regard to your income and the ACA.
We will discuss 1) use of Modified Adjusted Gross Income, 2)
tax credits (help paying for insurance), 3) your share of
the premium, 4) paying back the tax credits to the IRS, 5)
expansion of Medicaid and estate recovery which could affect
you if you are put into that plan, 6) inadequate coverage in
most subsidized plans, 7) penalties, 8) exemptions and 9) a
few tidbits. We’ll also take a look at the agenda of Enroll
America and the Health Insurance Exchanges, and what you can
expect to hear in the very near future.

Here we go. Fasten your seat belts.

1. HEALTH
INSURANCE EXCHANGE BASICS

In 2014, each state will have an Affordable Insurance
Exchange where qualified individuals and families with
incomes between 138 and 400 percent of the Federal Poverty
Level (FPL) can shop for commercial insurance policies. Most
individuals and families with incomes at or below 138
percent FPL will be put into Medicaid. You may be eligible
for help paying for your insurance in the form of a tax
credit. In most states, the Children’s Health Insurance
Program (CHIP) will continue to cover children in families
with incomes up to at least 200 percent FPL. Some states may
offer a Basic Health Plan for those who earn up to 200
percent FPL and are not eligible for Medicaid. Under limited
circumstances, you may also be eligible for a cost-sharing
credit.

Eligibility to receive a tax credit, the amount of your tax
credit and your out-of-pocket share for the insurance will
be determined by your income and where you fall in the
Federal Poverty Level Guidelines (FPL). This is easy to
understand.

Your annual gross income determines which FPL you’re in. For
example, based on 2012 FPL Guidelines, an individual with an
annual income of $33,510 is at 300 percent FPL; a family of
4 with an annual income of $69,150 is at 300 percent FPL. To
see where you’re at, try the handy calculator at this link.
FPL Guidelines are revised every January, so the 2013
edition should be up soon.
http://www.safetyweb.org/fpl.php

The ACA requires use of MODIFIED ADJUSTED GROSS INCOME
(MAGI) instead of Adjusted Gross Income for all
determinations made by an Exchange including eligibility for
Medicaid except in certain cases. So, in this lesson, we’ll
refer to annual income as MAGI.

Modified Adjusted Gross Income (MAGI) is defined as Adjusted
Gross Income PLUSa) all tax exempt
interest accrued or received in the taxable year;b) the non-taxable
portion of Social Security benefits provided under Title II
of the Social Security Act which includes old-age benefits,
disability benefits, spousal benefits, child benefits,
survivor benefits and parental benefits;c) tier 1 Railroad
Retirement benefits that are not includible in gross income;
andd) the exclusion from
gross income for citizens or residents living abroad.

The adoption of MAGI, created by the ACA, is defined in a
new section of the IRS code.

2.
DETERMINING ELIGIBILITY FOR A TAX CREDIT

The tax credit is to help you pay for insurance. The ACA
says it must be based on annual income for the tax year it’s
received, but since you will need help paying for your plan
during that year, the ACA allows for advance payment of the
tax credit.

Here’s an example of what that means: Let’s say you apply
for insurance at an Exchange in 2014. Therefore, 2014 is the
tax year you will receive your tax credit, and per the ACA,
the amount you receive must be based on that year’s MAGI.
But, that year’s MAGI won’t be available until 2015 when you
file your 2014 tax return and you need help paying for your
insurance plan when you buy it in 2014. So, the amount of
your tax credit has to be determined on information that is
available such as your prior-year (2013) tax return. Thus,
the tax credit morphs into an ‘advance payment of the tax
credit’ (also referred to as an advance premium assistance
credit). Now you see why 2013 is an important year for many
of you.

The ACA allows for limited disclosure of tax return info in
order for an Exchange employee to verify your citizenship
status and MAGI, and, not only to let you know how much your
advance tax credit will be, but also to see if you are
eligible to receive this in the first place. An Exchange can
also consider using your real-time income by looking at your
state’s most current quarterly wage database, or it may
agree to accept paper verification (pay stubs, etc.) as a
last resort or an attestation of your income with no
verification. Creation of a federal ‘data services hub’ is
in the works so your income information will be more readily
accessible. But, no matter how this plays out, you’ll still
receive an advance payment of the tax credit because your
actual MAGI for 2014 will not be known by you nor can it be
verified by an Exchange until you file your 2014 tax return
in 2015.

Ultimately, no matter which method is used – prior year or
partial current year – this advance payment of the tax
credit carries with it some heavy-duty consequences which
are discussed in topic 4 of this lesson.

3. TAX
CREDITS AND YOUR SHARE OF THE PREMIUM

The amount of your tax credit will be based on the second
lowest-cost Silver plan in the area where you live and your
MAGI. Here’s how this works – it’s quite simple:

a)
First, the amount you will pay out of your pocket for that
Silver plan – copays and deductibles not included – will be
a specific percentage of your MAGI, and you will pay this to
the insurer on a monthly basis. The way this percentage will
be calculated is described a few lines down.

b)
Next, your share will be deducted from the cost of that
Silver plan and the difference will be your tax credit which
the government will pay directly to the insurer on a monthly
basis when you purchase a plan.

The specific percentage you will have to pay for the second
lowest-cost Silver plan will be based on your FPL using a
well-greased sliding scale. As your FPL increases little by
little, the percentage you will pay increases. The same
percentage applies to an individual or a family. Here’s how
much of your MAGI you will pay for that Silver plan:

— up to 138 % FPL: 2% for people legally present less than 5
full years and residents of states that do not expand
Medicaid
— 138-150% FPL: 3 to 4%
— 150-200% FPL: 4 to 6.3%
— 200-250% FPL: 6.3 to 8.05%
— 250-300% FPL: 8.05 to 9.5%
— 300-400% FPL: 9.5% - there’s no range, but the dollar
amount of your share will change because 9.5% of a lower
MAGI is less than 9.5% of a higher MAGI.

Here are two examples in dollars using 2012 FPL Guidelines
and an estimate for a second lowest-cost Silver plan which
will vary depending where you live – actual costs are not
yet available:

a) You
are 35 years old and the price of the second lowest-cost
Silver plan for an individual in the area where you live is
$4,750 with no tax credit. If your MAGI is $33,510
($2,792.50 per month) putting you at 300 percent FPL, your
share for that Silver plan, per the chart above, would be
9.5 percent of your MAGI which comes to $3,183 ($265.25 per
month). Your tax credit would be $1,567 which is the
difference between the unsubsidized cost of that Silver plan
and your share.

b) You
are 35 years old and your MAGI is $27,925 ($2,327 per month)
putting you at 250 percent FPL, so, your share of that
Silver plan would be 8.05 percent of your MAGI which comes
to $2,247.96 ($187.33 per month) and your tax credit would
be $2,502.

If the second lowest-cost Silver plan is too expensive, you
can apply your tax credit to a Bronze plan which will be
cheaper but less comprehensive. If you want a better plan
than the Silver, you will have to pay the full difference in
the premium.

Don’t forget that your share of the monthly premium will be
figured on your MAGI which is pre-tax income. So, after you
deduct your income taxes and your share of an insurance
plan, will you be able to cover your monthly basic living
costs including paying off debt you may owe and still have
some cash left to pay for medical care if you have to use
your insurance? Check out topic 6 in this lesson for a
rundown of plans and coverage you can expect to find at an
Exchange. Hope you don’t faint.

￼Once you purchase a plan, your share and your tax credit
won’t change until the next enrollment period unless, before
that time, your income goes up or down enough to bump you
into a different FPL or you get a job with insurance. You
can let your Exchange know by phone or via your online
account, or, your Exchange might notice while cruising the
data services hub you learned about in topic 2 and notify
you that you must ‘up’ your coverage or that you’ve been
tossed into Medicaid if your MAGI has decreased enough to
make you eligible for that plan. Exchanges will be
encouraged to use as many different avenues as possible
including private databases to keep tabs on your income.

Thus, you could end up bouncing from Medicaid to a
subsidized plan or vice versa. By the same token, you could
take some extra work to help pay the bills or to save for a
vacation, and, oops, you went over 400 percent FPL and are
no longer eligible for a tax credit. The Exchange may not
find out about this unless you spill the beans, but, no
matter how it all plays out, income changes will catch up
with you when you file your tax return.

To be eligible for a tax credit you must file your tax
return no later than April 15. Married taxpayers must file a
joint return. Individuals who are listed as dependents on a
return are ineligible for a tax credit.

If you are eligible for Medicaid, you will not be allowed to
receive a tax credit or a cost-sharing credit although some
states impose premium and cost-sharing charges on certain
Medicaid enrollees per the Deficit Reduction Act of 2005 (DRA)
and clarified in the Tax Relief and Health Care Act of 2006.

Affordability rates (the percentage of your MAGI the
government has decided you can afford to pay for insurance)
are based on boardroom formulas which don’t take particular
individual needs into account such as housing costs,
property taxes, debt, education, transportation, retirement
savings, etc. Also, FPL Guidelines are standard across the
country and do not take into consideration those who reside
in a more expensive region or vice versa. They are
one-size-fits-all with the exception of Alaska and Hawaii.
See topic 8 in this lesson to learn about exemptions.

Check out what self-proclaimed health care expert Jonathan
Gruber says about affordability and get a load of all the
“formulas.” According to Mr. Gruber, you may be having too
much fun in life and need to get serious, buy health
insurance and live under a rock in order to pay for it. He
was involved with Romneycare in Massachusetts and was also
Mr. Obama’s go to man under a no-bid contract. Per a bar
graph on page 6 of a report prepared by Stan Dom for the
Urban Institute, subsidized plans under the ACA are
estimated to cost 2 to 3 times more (give or take) than the
subsidized plans under Romneycare. Per several surveys
during the years that Romneycare has been in effect, many
low and modest income MA residents have had difficulty
paying for those plans and the out-of-pocket costs to use
the insurance, particularly chronically-ill residents.
http://ebookbrowse.com/1493-gruber-will-affordable-care-act-make-hlt-ins-affordable-reform-brief-v2-pdf-d124754327
http://www.statecoverage.org/files/TheBasicHealthProgramOptionUnderHealthReform.pdf

4. PAYBACK OF
TAX CREDITS TO THE IRS

Perhaps you recall hearing politicians including Mr. Obama
say if you can’t afford to pay for health insurance, the
government will help you. That was one of the key talking
points repeated non stop. We just went over the help part –
the tax credits. Now we’ll look at what Mr. Obama et al
didn’t tell you which is important to understand because it
could cause you some serious financial distress.

Remember the “advance payment of the tax credit” in topic 2
of this lesson? Well, essentially, that was a loan from the
government which was paid in advance to the insurer on your
behalf when you purchased your plan, and, as you know, loans
have to be paid back. So, when you file your tax return for
the year you received your “advance tax credit” (your loan),
if your income has changed, you have to settle this with the
IRS. Here’s the deal:

a) If
your MAGI is higher and the increase puts you into a higher
FPL, you may have to pay back a portion or all of the tax
credit because it was based on a lower MAGI. In other words,
you could have an additional tax liability on top of the
income taxes you already paid (or still owe) because you
received a higher tax credit than you were entitled to.

￼b) If
your MAGI is lower and the decrease puts you into a lower
FPL, a refund could be coming to you because you were
eligible for a larger tax credit than the government paid to
the insurer. In other words, you overpaid for your portion
of the insurance premium.

c) If
you earned a bit more or less, but your extra earnings or
loss didn’t bump you into another FPL, you’re home free.

To figure out your payback, you will have to enter the
relevant figures on the reconciliation page of the tax
return. Changes in filing status such as the number of
people in your household will also have an impact. For those
of you who marry or divorce, the rules for the payback
amount as well as the amount of the tax credit you are
eligible to receive will make your head spin – the
computation includes pre- and post-marriage FPL and uses the
highest FPL of the two people involved. Ditto for divorce.

Here is one of the reconciliation explanations in IRS-speak:
Your liability for an excess tax credit you received must be
reflected on your current year income tax return subject to
a limitation on the amount of such liability.

Oh! Limitation on the amount of such liability. That sounds
good.

Let’s take a peek at the payback limitations on record at
the time of this writing. “At the time of this writing” are
the operative words because the cap has been increased twice
since the ACA was signed into law. The original payback was
capped at $400 for families under 400 percent FPL and $200
for individuals. We’ll skip over the first increase. The
story behind the second one is that a particular revenue
stream was removed from the original law, so something had
to be done to compensate for this lost money. Thus, an
amendment was passed that increased the cap using a sliding
scale, thereby putting a huge financial burden on the backs
of the very people the ACA claims to help. In other words,
tag, you’re it. You are the cash cow.

Here are the current sliding-scale caps:

If the household income (expressed as a percent of poverty
line) is:
less than 200 percent, the applicable dollar amount is $600
at least 200 percent but less than 300 percent, the
applicable dollar amount is $1,500
at least 300 percent but less than 400 percent, the
applicable dollar amount is $2,500

Effective date: the amendment made by this topic shall apply
to taxable years ending after December 31, 2013. Very truly
yours, House Ways and Means Committee

b)
Also, per IRS final regulations: for taxable years beginning
after December 31, 2014, the payback caps may be adjusted to
reflect changes in the consumer price index.

Payback amounts are reduced to one-half for unmarried
individuals who are not surviving spouses or filing as heads
of households. There is no help if you get hit with a
payback and many of you will have difficulty paying this
liability.

Chances that you may have received an incorrect tax credit
are not exactly slim because this poorly thought-out scheme
does not take into account the unpredictable and complex
financial situations that confront the low and modest income
population.

Keep in mind that by ending up in a higher FPL, you may also
have to pay more out of your pocket for an insurance
premium. You learned how that works in topic 3. If you can’t
afford a higher premium and drop your insurance, you may
still owe a payback plus a penalty for being uninsured which
is also MAGI-based. Penalties are discussed in topic 7. If
your MAGI puts you over 400 percent FPL, you just knocked
yourself into left field and are on your own paying for an
insurance plan on the open market. And, you may also be
required to payback the entire tax credit.

If you get a job during the current year that offers health
insurance which is not more than 9.5 percent of your total
salary and the coverage is not less than 60 percent, you
must take that insurance or pay a penalty for being
uninsured. But, you may owe a payback for the months you
received a tax credit before you landed the job. How large
that payback is will depend on your MAGI for the entire tax
year, not just on your income during the months you received
the tax credit. Or, you may lose a job during the year and
have a significantly reduced income even though the amount
reported on your tax return is high because you had a job
for part of the year. In this case as well, your payback
will be based on your MAGI for the entire tax year.

More interest income from taxable and tax-exempt savings or
a year-end bonus could also contribute to an increased MAGI
and the possibility of a payback as well as taking extra
work to help pay the monthly bills, house and car repairs,
educational aspirations or a vacation. So, whether or not
you end up in payback land will depend on how close you are
teetering on the edge of an FPL. Ditto for your share of the
premium and the amount of your tax credit.

The payback may stop many of you from purchasing insurance
at the Exchange because you know in advance you will not
have the money to pay it. If this is the case, you may be
allowed to negotiate a lesser tax credit by paying more out
of your pocket for your monthly insurance premium in order
to avoid or decrease the payback. It’s a crap shoot.
Considering what you’ve learned so far in today’s lesson,
many of you will find yourselves between a rock and a hard
place under the ACA, and you will be forced to make unten-
able choices. Given the skyrocketing costs of food, heat and
other basics, how will you even tread water under this
set-up, nevermind get ahead?

Being told you will receive help from the government if you
can’t afford to purchase insurance and finding out at tax
time this was really a loan and you owe the IRS a
substantial debt on top of your income taxes is outright
shameful. But most politicians have no shame – which brings
us to the next topic.

5. MEDICAID
EXPANSION AND ESTATE RECOVERY

In order to expand Medicaid, several Medicaid regulations
were changed:

a) the
income limit for eligibility was increased to 133 percent
FPL, but since states must apply a 5 percent disregard, this
effectively raises the eligibility to 138 percent FPLb)
Modified Adjusted Gross Income will be used in most cases to
determine eligibility (also applies to certain CHIP
applicants)c) the
age limit was increased to 64, childless adults will be
eligible; andd) the
asset test was dropped except for certain groups such as the
elderly and people on Social Security Disability – BINGO!

The fact that the asset test was dropped is very important,
but before we look at why, you must first understand that if
an Exchange determines you are eligible for Medicaid, you
have no other choice. Code for Exchanges specifies, “an
applicant is not eligible for advance payment of the premium
tax credit (a subsidized plan) or cost-sharing reductions to
the extent that he or she is eligible for other minimum
essential coverage, including coverage under Medicaid and
CHIP.” Therefore, you will be tossed into Medicaid unless
there are specific rules as to why you would not be
eligible. If you are enrolled in a private plan through an
Exchange and have been receiving a tax credit, and your
income decreases making you eligible for Medicaid, in you
go. If you are allowed to opt out because you don’t want
Medicaid, you will have to pay a penalty for being uninsured
unless you can afford to purchase insurance in the open
market.

Just so you’re clear on this: the ACA stipulates that the
system will ensure that if any individual applying to an
Exchange is found to be eligible for Medicaid or a state
children’s health insurance program (CHIP), the individual
will be enrolled in such a plan.

Furthermore, to increase enrollment in health coverage
without requiring people to complete an application on their
own, states are advised to automate enrollment whenever
possible by using existing databases for social services
programs such as SNAP (food stamps) to enroll people who
appear eligible for Medicaid but are not currently enrolled.
Therefore, you could find yourself auto-enrolled in Medicaid
against your will if your state acts on this advice.

Many times over Mr. Obama et al told you that all Americans
would have choice. Choice was another big talking point. Are
poor and low-income Americans undeserving of choice? Is the
ACA a class-based system? Maybe they meant that for this
segment of the population, the choice would be between
Medicaid or a penalty for remaining uninsured. This is
blatant discrimination.

Here’s why dropping the asset test got the BINGO – Estate
Recovery! You won’t find the following info in the ACA. It’s
in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a
federal statute which applies to Medicaid, and, if you are
enrolled in Medicaid, it will apply to you depending on your
age.

a)
OBRA 1993 requires all states that receive Medicaid funding
to seek recovery from the estates of deceased individuals
who used Medicaid benefits at age 55 or older. It allows
recovery for any items or services under the state Medicaid
plan going beyond nursing homes and other long-term care
institutions. In fact, The Centers for Medicare & Medicaid
Services (CMS) site says that states have the option of
recovering payments for all Medicaid services provided. The
Department of Health and Human Services (HHS) site says at
state option, recovery can be pursued for any items covered
by the Medicaid state plan.

b) The
HHS site has an overview of the Medicaid estate recovery
mandate which also says that at a minimum, states must
pursue recoveries from the “probate estate,” which includes
property that passes to the heirs under state probate law,
but states can expand the definition of estate to allow
recovery from property that bypasses probate. This means
states can use procedures for direct recovery from bank
accounts and other funds.

c)
Some states use recovery for RX and hospital only as
required by OBRA 1993; some recover for a few additional
benefits and some recover for all benefits under the state
plan. Recovery provides revenue for cash-strapped states and
it’s a big business.

Your estate is what you own when you die – your home and
what’s in it, other real estate you may own, your bank
account, annuities and so on. And even if you have a will,
your heirs are chopped liver. Low-income people often have
only one major asset – the home in which they live and, in
some cases, this has been the family home through several
generations.

So what this boils down to is: if you are put into Medicaid
– congratulations – you just got a collateral loan if you
use Medicaid benefits at age 55 or older! States keep a
running tally.

Estate recovery can be exempted or deferred in certain
situations after your death, but the regulations for this
are limited and complicated with multitudes of conditions.
You may not have an attorney on speed dial, but with regard
to this hundred pound gorilla, it sure would be handy.

Should you decide to ask your congresscritter about estate
recovery, be prepared for responses such as:

—
“Estate recovery doesn’t apply to you.” (Great news. Please
overnight a copy of the amendment to OBRA 1993 that
stipulates estate recovery is no longer required and no
longer allowed. Here’s my address.)— “Oh,
estate recovery is state, I’m federal.” (Wrong – estate
recovery is federally mandated although the estate recovery
program itself is administered by each state.)— “I
don’t know anything about this.” (Highly unlikely because
the expansion of Medicaid is an integral part of the ACA and
estate recovery is not a secret.)— “The
ACA wasn’t about revamping Medicaid.” (As explained above,
Medicaid regs were revised in order to expand Medicaid.)—
“I’ll look into that and get back to you.” (Don’t hold your
breath – they don’t want to go there.)

If you ask about estate recovery when you contact an
Exchange or speak with an outreach agency, you’ll probably
run into a brick wall or be told it doesn’t apply to you –
whatever. But, it doesn’t matter because what you are told
is not legally binding. What is legally binding is your
signature on the Medicaid application which indicates that
you agree to the terms of the contract – which brings us to
another item in OBRA 1993. Read on.

OBRA 1993 also contains procedural rules intended to ensure
that individuals are informed about Medicaid program
requirements including disclosure of estate recovery before
they complete the application process and also during the
annual re-determination process. Notification of estate
recovery should be on the signature page of your state’s
Medicaid application and is usually a one-liner: I
understand that if I am aged 55 or older, (name of your
state’s Medicaid plan) may be able to get back money from my
estate after I die. (Use of the word ‘may’ doesn’t mean if
the state feels like it – it means recovery will take place
unless there are specific circumstances for exemption or
deferment as mentioned above.) There are also strict
recovery/repayment clauses for injury-related settlements
disclosed on the signature page and a few other ditties that
apply to you or a family member who is enrolled in Medicaid.
All of these items must also be disclosed in your state’s
Medicaid handbook.

Under the ACA and proposed federal rules for implementation,
states will be required to provide a single, simple
application to apply for and enroll in Exchange plans,
Medicaid and CHIP, and consumers must be able to apply by
phone, in person or online. The Secretary (HHS) is charged
with this task and it’s in the works. This begs an answer to
the following questions:

— Will
Medicaid applicants be diligently informed about estate
recovery and other rules that apply to Medicaid enrollees on
this single application? Failure to do so would be in non
compliance with OBRA 1993 and would also be deceptive.— Will
applicants be provided with a signature page that contains
appropriate disclosure of these rules so they can be
reviewed before signing on the dotted line?— How
will appropriate disclosure and obtaining a signature work
for those who are bumped into Medicaid due to a decrease in
income or who might be auto-enrolled because they were
presumed eligible through a database.

If an applicant or someone who has been bumped or
auto-enrolled in Medicaid is not satisfied with the terms of
the Medicaid contract, lack of another health insurance
option that is in the best interest of low-income earners
represents undue and unconscionable advantage being taken of
this segment of the population under a law that mandates
health insurance or a penalty.

Do the health insurance policies enjoyed by lawmakers on
Capitol Hill and paid for by taxpayers include an estate
recovery program?

Medicaid is poor, underfunded, overstretched and constantly
bombarded by state budget cuts – even before an ACA
expansion. It offers a low quality of care in many states,
and, in general, represents inequities in care. Office-based
doctors typically refuse to accept Medicaid patients, thus,
millions thrust into this plan will have difficulty finding
a primary-care doctor or a specialist.

A perfect example is the December 2012 federal appeals court
decision that allowed California to cut reimbursements by 10
percent to doctors, pharmacies and others who serve
low-income residents under the state’s Medi-Cal plan (a
version of Medicaid) due to state budget issues. California
was already at the bottom of the rate-reimbursement heap
which made finding doctors difficult for residents in Medi-Cal.
This decision will further reduce the number of health care
providers willing to take new Medi-Cal patients, thus
jeopardizing their access to primary and specialized care.
Under the ACA’s expansion of Medicaid, state budget crises
across the nation will exacerbate the ongoing problems
regarding access to care for Medicaid patients, particularly
in states that have a high low-income population.
http://www.sfgate.com/health/article/Medi-Cal-cuts-upheld-by-appellate-court-4116971.php

6. INSURANCE
PLANS AT THE EXCHANGES

Below are the 4 plan levels that will be offered at
Exchanges for people between 138 and 400 percent FPL. Each
one has government- approved benefits including prescription
coverage. You will be entitled to one free preventive visit
each year. Per the most recent study commissioned by the
Kaiser Family Foundation, several cost-sharing options were
estimated for non-group (individual and family) Bronze and
Silver plans. Cost-sharing is the amount you must pay to use
your insurance. Your share of the premium is not part of
cost-sharing.
http://www.kff.org/healthreform/upload/8303.pdf

The way this works is you will pay for all your medical care
until you reach the annual deductible. Then you’ll pay the
applicable percent- age of coinsurance until you reach the
annual out-of-pocket spending cap which will be set on a
sliding scale. Annual means these amounts start again the
following year, and if they change, you will find out when
you re-apply for insurance. There will also be copays – an
amount you will pay to the doctor for an office visit.
Here are the current estimates:

Bronze: cheapest and dry as dust with 60/40 coverage – a
win-win for insurersa)
annual deductible of $4,375 for an individual (double for a
family) with 20 percent coinsurance, b)
annual deductible of $3.475 for an individual (double for a
family) with 40 percent coinsurance

Silver: next cheapest – offers an illusion of coverage at
70/30a)
annual deductible of $2,050 for an individual (double for a
family) with 20 percent coinsurance, b)
annual deductible of $650 for an individual (double for a
family) with 40 percent coinsurance

A fifth plan will be available for the under-30 crowd and
people who have been granted a hardship exemption. See topic
8 in this lesson. Coverage in this plan will be less
comprehensive than the Bronze – it is primarily for
major-medical expenses except that it has a free preventive
visit. Cost-sharing for people at 138 to 200 percent FPL is
estimated to be a bit less than the Bronze and Silver
estimates mentioned above.
￼
The high deductibles in all but the two most expensive plans
could saddle you with mounting bills for routine care and
may stop you from seeking necessary treatment for illness or
injuries. Many of you will find that the promise of access
to affordable health care really means access to inadequate
coverage at a price the government has decided you can
afford to pay.

The number of drugs in each plan at an Exchange will vary
from state to state. In some states, plans will offer up to
99 percent of available drugs and others only 45 percent
which means you may not have access to the specific drugs
you need. Perhaps Big Pharma will change its stance on this
before 2014.

The cost of plans at an Exchange will vary from state to
state based on where you live and your age. The ACA allows
insurers to charge older customers up to three times more
for a plan, even if they are in good health, as long as the
state in which an Exchange is located doesn’t have a law
that caps age-rating. Some Exchanges will tuck an
administrative fee of 2 to 4 percent into premiums to help
cover operating expenses.

Cost-sharing tax credits will be available if you are below
250 percent FPL to protect you from high deductibles and
copays – but only if you purchase a Silver plan. If you buy
the cheaper Bronze plan, you won’t be eligible for these
credits, which are, by the way, direct federal payouts to
private health insurance companies.

Obamacare has no cost controls. There is nothing stopping
the insurance companies from increasing their rates, and
Washington has already estimated higher premium costs at the
Exchange for 2016 which doesn’t mean that 2015 won’t have an
increase. Sounds like 2014 prices will be an Introductory
Offer. Get ‘em while their hot!

7. PENALTY FOR BEING UNINSURED

The ACA requires that people who have been deemed able to
purchase health insurance but decide not to buy it starting
in 2014 will owe a penalty (a tax) to the IRS. Here’s what
this looks like:

a) In 2014, the annual
penalty will be $95 per adult and $47.50 per child, up to a
family maximum of $285 or 1 percent of family income,
whichever is greater.b) In 2015, the penalty
will be $325 per adult and $162.50 per child, up to a family
maximum of $975 or 2 percent of family income, whichever is
greater.c) In 2016, the penalty
will be $695 per adult and $347.50 per child, up to a family
maximum of $2,085 or 2.5 percent of family income, whichever
is greater.

The IRS collects the penalty, but the ACA stipulates that
taxpayers shall not be subject to any criminal prosecution
or penalty, tax liens, seizure of bank accounts or
garnishment of wages for failure to pay it and no
accumulation of interest on the unpaid balance. So, it
appears that all the IRS can do is deduct the penalty from a
refund it owes you, and if you’re not due a refund, then
you’ll have an out- standing tax obligation.

Keep in mind that the penalty is described in annual amounts
but is really monthly. So, if you are uninsured for only
part of the year, you will accrue only 1/12 of the total for
each month you are uninsured unless you qualify for an
exemption.

8. EXEMPTIONS FROM THE PENALTY

You may be eligible for official permission that excuses you
from having to pay the penalty for being uninsured. The
requirements are:

a) If the cheapest
health care plan available costs more than 8 percent of your
MAGI after subtracting the tax credit or employer
contribution, whichever is applicable. b) Your income is so low
that you aren’t required to file federal income taxes.c) You are between jobs
and without insurance for up to three months.d) You have a
sincerely-held religious belief that prevents you from
seeking and obtaining medical care.e) You are in jail.f) You are an
undocumented immigrant.g) You are a member of
an Indian tribe or a religious group currently exempt from
paying Social Security tax.

If item d) is the case, you must file a sworn statement as
part of your tax return, and should you obtain care during
the tax year, the exemption will no longer apply and you
will have to pay a penalty for being uninsured. Per H.R.
6597, medical care is defined as acute care at a hospital
emergency room, walk-in clinic or similar facilities.
Medical care excludes treatment not administered or
supervised by a medical doctor such as chiropractic, dental,
midwifery, personal care assistance, optometry, physical
exams or treatment where required by law or third parties
such as an employer, and vaccinations.
￼
If you think you can’t afford the amount the government has
decided you can afford to pay for your insurance plan, and
you don’t fit into any of the categories described above,
you can apply for a Hardship Waiver. Details have not yet
been provided regarding hardship eligibility requirements
under the ACA, but, for an idea of what they might look
like, let’s check out what the deal is in Massachusetts
which already has a mandated health insurance law –
Romneycare! In fact, Romneycare was the model for Obamacare.
That’s why some people call Obamacare, Obamneycare.

To qualify for a Certificate of Exemption under Romneycare,
a Massachusetts resident must demonstrate that health
insurance is not affordable due to one of the following:
1) homelessness;
2) eviction or
foreclosure notice; 3)
domestic violence-related medical trauma;
4) major long-term
illness of a child; 5)
death of your spouse; 6)
your house burned down; or 7)
“you can establish that the expense of purchasing health
insurance would cause you to experience serious deprivation
of food, shelter, clothing or other necessities.”

Ya gotta luv number 7. And in Massachusetts, exemptions come
with an expiration date, so you have to clean up your act in
short order. Under the ACA, the Secretary of Health and
Human Services will determine if, indeed, you have suffered
a hardship that keeps you from being able to pay for
coverage.

9. OTHER TIDBITS

There is much more in the ACA including all kinds of rules
and penalties for employers, employees and the self employed
as well as the Accountable Care Organization (ACO) model
which will be mandated starting in 2014. The latter works as
follows: under the simplest option available, a small group
of doctors and hospitals – an ACO – will manage your care
and be graded and paid based on the outcome of all patients
who seek treatment with that ACO. The ACO will also be
rewarded with a share of the savings in health costs it
achieves by following best treatment practices and reaching
specific benchmarks set by CMS. The second option, “shared
savings plus risk,” is for larger ACOs. Providers will
receive a lump-sum payment to treat their patients and
assume a portion of the risk for above target spending but
are eligible to keep a greater portion of the savings.

Either of these options reduce patient care to numbers and
paperwork because doctors are essentially controlled and
incentivized by an administrator in some far-flung office.
The ACO model is the insurance industry’s version of
“budgeting” the cost of health care which ultimately
benefits insurers at the expense of doctors and their
patients.

The ACA also requires Health Insurance Exchanges to
establish a navigator program to inform the uninsured about
the availability of government-approved subsidized plans at
an Exchange and to facilitate enrollment in these plans, but
it leaves the design of the program up to each Exchange.

Depending how an Exchange sets up its program, some
Navigators will sell plans offered by an Exchange while
others will be responsible for maintaining the existing
market but may also be allowed to sell Exchange plans. All
seller Navigators will be compensated either by Exchanges or
insurance carriers for the plans they sell. Many options are
being considered by Exchanges including using insurance
agents. Hopefully, Navigators and insurance agents will not
be knocking on your door or contacting you by phone. That
would be over the top. Here’s a link to read what the
California Exchange is pondering with regard to its
Navigation program.
http://www.healthexchange.ca.gov/StakeHolders/Documents/CHBE,DHCS,MRMIB_StatewideAssistersProgramDesignOptionsRecommendationsandWorkPlan_6-26-12.pdf

Since many Americans don’t know about the ACA, somehow the
word has to get out and people must be encouraged to
purchase health insurance either in the open market or at an
Exchange. And who better to do this?

Enter “Enroll America” – a nonprofit 501(c)3, financially
backed by Aetna, Blue Cross Blue Shield, UnitedHealth,
America’s Health Insurance Plans, hospitals, associations
that represent drug manufacturers and nonprofits with vested
interests. For insurers and pharma, the ACA is manna from
heaven – scratch that – manna from Capitol Hill – and the
dollar signs in their eyes are on fire! These profit seekers
and connected nonprofits will be using every avenue possible
to maximize their bottom lines.

The mission of Enroll America per its website is to “ensure
that all Americans are enrolled in and retain health
coverage.” It’s Board of Directors and Avisory Council reads
like a Who’s Who in the Medical Industry Cartel – CEOs,
presidents, vice presidents and directors of such entities
as the American Hospital Association, Express Scripts,
Medicaid Health Plans of America, Kaiser Permanente and many
others – the list is long. If you would like to donate to
these mega-profit vultures, you can do so on the Enroll
America home- page. The goal is $100 million by 2014.
http://www.enrollamerica.org

In its publication, “Ten Ways to Make Health Coverage
Enrollment and Renewal Easy,” Enroll America has recommended
availability of web-based applications to increase the
places where people can enroll in coverage: at home, at
grocery stores, community health centers, state fairs,
sporting events, places of worship, and more. Gee, you can
apply for insurance while you pray. How thoughtful.
http://www.enrollamerica.org/best-practices-institute
￼
The strategy for insurers and state Exchanges to persuade
you to purchase insurance and warn you about the penalties
includes using ads, social media, blogs, YouTube, Flickr,
Twitter, hospitals, health centers, McDonald’s, in-store
radio announcements, ballparks, county fairs, libraries,
laundromats, community events, libraries, county fairs and
drugstores – you name it. Blue Cross Blue Shield has
partnered with H & R Block. Health insurers are already
setting up shop inside some supermarkets so they can answer
your questions and sign you up for coverage while you do
your grocery shopping. They will likely be showing up in
shopping malls – maybe even in parking lots, on street
corners and at church fairs. And, their aim is to recreate
themselves from the bloodsucking leeches that they are to
your new, cool-dude friends.

We’ll be living in Occupied Territory.

Let’s connect some dots. The executive director of Enroll
America is Ron Pollack, also president of Families USA – a
nonprofit and friend of the industry. On its website,
Families USA bills itself as “a national non-partisan
organization dedicated to the achievement of high quality,
affordable health care for all Americans.” Philippe Villers
and Robert Crittenden, M.D. are on Families USA Board of
Directors. Mr. Villers is also on the BOD of Herndon
Alliance, Bob Crittenden is a Herndon staff member and Ron
Pollack is a Herndon founder.
http://www.familiesusa.org

Herndon Alliance is an influential health care spinmeister
creating messaging to change public opinion and tweaking
each message to reach particular groups.

Herndon has close ties to Capitol Hill and helped market the
ACA providing words politicians and supporters should use to
promote the bill. For example, during the national health
care debacle a few years ago, you heard Mr. Obama et al
continually talk about ‘choice,’ ‘we need a uniquely
American solution,’ ‘fair rules,’ ‘investing in America’s
future’ and ‘high-quality, affordable healthcare.’ That last
one is used in Families USA mission statement. The Council
for Affordable Health Insurance, a frontgroup for the
industry, gets right to the point – its name. Ron Pollack
worked with the Obama administration to help reshape public
opinion of Mr. Obama’s unpopular health care bill. Leading
up to 2014 when the Exchanges are scheduled to open, there
will most likely be a blitz of TV ads in which you will hear
many of these same nebulous, feel-good words. And, you’ll
undoubtedly read or hear plenty of Herndon spin from your
Exchange and throughout your state in the immediate future.

In the interest of coming up with messaging, Enroll America
held a few focus groups and commissioned a nationwide survey
in fall 2012. Research was provided by Celinda Lake from
Lake Research Partners, a national public opinion and
political strategy research firm. One takeaway was when a
monthly premium cost was given, the majority of people
polled thought that it was too expensive and the ACA would
not provide affordable and comprehensive coverage even with
the government tax credits (subsidies). So, Lake Research
Partners advised Enroll America not to mention specific
costs but to use the phrase ‘free or low-cost plans.’
http://www.nytimes.com/2012/12/20/us/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all

Herndon has been working on messaging various parts of the
ACA that will be used by outreach partners, insurers and
state Exchanges. Its messaging is not based on truth or
evidence - Herndon actually stays away from any mention of
facts as you read above regarding the cost of plans.
Instead, its messaging is designed to mislead an uninformed
public.

— Here’s an award
winner: “Members of Congress will purchase their insurance
at the Exchange. If members of Congress are part of the
marketplace then it’s got to offer quality plans and
protections.”
http://herndonalliance.org/resources/research/communications-tips-exchange-talking-with-voters.html
￼— Stressing that under
the ACA insurers won’t be able to deny coverage for
pre-existing diseases is a Herndon biggie. In fact, you
heard this many times over from Mr. Obama and other
politicians. But a loophole in the law allows insurers to
rescind (cancel) your policy if you intentionally put false
or incomplete information on your application. The ACA says
you must be given at least 30 days’ notice before your
coverage can be rescinded, giving you time to appeal the
decision or find new coverage. So, if your care becomes
costly for the insurer and you didn’t mention you had a rash
on your arm when you were 15, that’ll work. How can you
prove if leaving this out was intentional or not? It’s them
against you.

Enroll America’s Best Practices Institute is publishing a
series of briefs on the best way to write and design
websites and marketing materials, no doubt, using Herndon
messaging. PR and marketing firms are helping various state
Exchanges come up with appealing branding such as using a
name everyone will like and spiffy logos with cool type
styles in colors that will appeal to all audiences. Branding
lessons include advising Exchanges which words to ‘embrace’
such as emphasizing choice, control, transparency and
competition. Other messaging includes, “the Exchange should
be viewed as an educator, not an enforcer” and using the
word ‘marketplace’ instead of Exchange is a must. Tennessee
Health Care Campaign will be telling potential customers “.
. . the exchange offers us more choices, greater control
over our health care, and more competition to control
costs.” It’s all Herndon’s handywork in one form or another.
http://dhmh.maryland.gov/exchange/pdf/Brand_Recommd_may182012_final.pdf
http://www.thcc2.org/PDFs/rtm_exchange_talking_point.pdf

More choice means choice of insurance companies, not choice
of doctors and hospitals. In rural areas, there may be only
one insurer offer- ing plans which means one network and
doctors may not be taking new patients. This happened in MA
under Romneycare, and on top of that, many doctors would not
accept people in the subsidized plans because of
time-consuming red tape and low reimbursement rates. Under
the ACA, insurers are planning to limit networks in the
cheaper plans at the Exchanges. Having too few doctors in a
network is a means of suppressing the use of health care
which increases an insurer’s profits. Further on in this
lesson, you’ll learn that the Maryland Exchange has been
advised to ignore negative problems such as not enough
doctors to serve the newly insured.
http://www.kaiserhealthnews.org/Stories/2013/January/23/HMO-limited-networks-comeback-in-exchanges.aspx

Choice is definitely a non starter for people found eligible
for Medicaid – the ACA allows no other choice for this
segment of the popula- tion and many doctors do not accept
Medicaid. As for giving you greater control, considering all
the rules about income and FPL, not to mention the
data-mining to monitor your income during the year and those
nasty tax credit paybacks, it’s you who is being controlled.
And competition? Read this stunning op-ed by Nomi Prins:
“Real Danger of “Obamacare” Insurance Company Takeover of
Health Care.”
http://www.nationofchange.org/real-danger-obamacare-insurance-company-takeover-health-care-1352648027

In Enroll America’s January 15, 2013 press release,
Executive Director Rachel Klein says the ACA offers the
promise of “access to comprehensive, affordable health
coverage.” That is a false promise. As you learned in this
lesson, coverage in the plans that will be offered at the
Exchanges, with the exception of the two most expensive, is
anything but comprehensive – the cheaper plans are unafford-
able to use. Furthermore, how can she claim that the cost of
the plans are affordable? Ms. Klein should be well aware of
the nationwide survey Enroll America commissioned in which
the majority of people polled said that the plans are too
expensive. http://is.gd/4jlaUX
http://www.nytimes.com/2012/12/20/us/officials-confront-skepticism-over-health-law.html?ref=us&_r=0&pagewanted=all

Add up pay scales like that for every Exchange in the
country, throw in some bennies, a PR contract for each
Exchange, campaign costs and compensation paid by Exchanges
to Navigators for plans they sell – a grand and costly
effort to push more people into America’s for-profit health
care system. Your tax dollars at work and mega bucks that
could be used for actual hands-on medical care.

The Maryland Exchange has three campaign funding levels –
Basic, Plus and Full-Scale – with a total for year one, two
and three. Basic funding for year one is $2,450,000, Plus is
$4,000,000 and Full-Scale is $6,300,000. See p.137 at this
link for years two and three.
http://www.dhmh.maryland.gov/exchange/pdf/FinalAdvertisingReportWeber.pdf
￼
The following, from the maryland link above, gives you an
idea of some of the strategies that will be in play, most
likely in all states. The Maryland Exchange has been advised
by Weber Shandwick to “establish a system to monitor
newspaper, radio, TV and online conversations about the
Exchange and the program and to establish procedures and
priorities for responding to negative media stories, op-eds,
blogs and reports.” You can find this in the Risk Management
and Responses section of Maryland’s strategic marketing
plan.

In the Earned Media/Public Relations section, advice
includes “ . . . putting out stories on the first effective
enrollees, enrollment number milestones, and enrollee
testimonials. Each of these becomes the focus for positive,
brand-reinforcing stories. There will also be the risk of
negative stories, including potential topics such as
enrollment snafus, delays in issuing insurance cards, the
cost of Qualified Health Plans [government-approved plans],
claims of ‘shoddy’ Bronze coverage, incidents of physicians
refusing to accept enough new patients to serve the
uninsured and other negative topics.” “While coverage is
bound to include some level of criticism it can be success-
fully countered by putting a human face on heatlh reform.”

The Social and Digital Media section advises an invasion of
the Internet including social media to market health
insurance by “delivering the right messages to the right
audience at the right time,” (probably using Herndon spin)
to “help drive enrollment in the Exchange,” and also
flooding newspapers with op-eds to contradict reported
adverse effects of the ACA.

Exchanges certainly have a lofty goal – promote success
stories only and be ready to contradict and cover up the bad
stuff as quickly as possible. Massachusetts residents have
been there. The Connector and state politicians including
the governor made sure that anyone being harmed by
Romneycare would not be heard in spite of statewide survey
reports put together by outreach agencies advising state
legislators and powerplayers that low-income people were not
faring well under this law. Various issues were spelled out
and testimonials were included, but residents’ concerns
about the adverse effects of Romneycare were ignored. MA
national legislators also went along with this agenda as did
the mainstream media.

When $130 million was needed in 2009 to balance the
Massachusetts state budget, the Connector – with the
blessing of MA Gov. Deval Patrick and the MA legislature –
removed about 28,000 legal immigrants – working people
paying taxes – from their insurance plans. Another 8,000 or
so were barred from enrolling in insurance plans because the
MA legislature voted to cap enrollment in the subsidized
plans. This took place at the same time Mr. Obama was trying
to sell the ACA to the nation, so, under pressure from
Washington, the MA legislature restored some of the money,
and the Connector dumped these people, without their
consent, into an out-of-state plan with higher copays, less
comprehensive coverage and next to no doctors or safety net
hospitals in its network.
http://www.huffingtonpost.com/iyah-romm/lessons-from-massachusett_b_380718.html

This has huge implications for the ACA. If legal immigrants
can be removed from their plans and others denied enrollment
when a state budget is squeezed, which vulnerable segment of
the population is next in line? The good news is these legal
immigrants in MA sued the Connector and its then-Executive
Director, Jon Kingsdale, and the Massachusetts Supreme
Judicial Court ruled unanimously that the state could not
violate their right to equal protection under the state and
federal constitutions and fiscal considerations alone can
not justify a state’s invidious discrimination against them.
As a result of this decision, the state had to come up with
some bucks, and the Connector was forced to put the
plaintiffs back into their original plans.
http://www.healthlawadvocates.org/priority-areas?id=0015

Getting back to Enroll America, Herndon Alliance and some of
the less-than-honorable Exchange strategies – it’s one thing
to inform Americans about the ACA and Exchanges that offer
the possibility of either purchasing high-deductible or
catastrophic coverage with a loan from the government to
help pay for it or being tossed into expanded Medicaid –
but, mounting a costly, massive campaign to purposely
deceive and manipulate the public with the unstated goal of
more profit for the already extremely lucrative health
insurance industry is disgraceful.

Is the ACA a fair law if it helps only one small segment of
the population but hurts and exploits a larger number to do
so? The way this law works is fundamentally unfair and will
not bring medical care to the many, but, instead will
progress to greater personal debt for individuals and
families who can’t afford the “affordable” insurance as well
as those who must keep an eye on their income to avoid the
many traps and false ends this law creates. At their
expense, the forced purchase of health insurance will bring
increased revenue to the industry, not to mention more
kickbacks to Congress, and in the very near future, the
health insurance industry will be “too big to fail.”

The ACA is most definitely a “uniquely American solution”
which has little to do with reforming this country’s
barbaric health care system. It merely controls peoples’
finances and choices while leaving insurance companies in
charge and does virtually nothing to end their abuses. It
will leave many millions of Americans uninsured and millions
more underinsured at a staggering cost to taxpayers.
￼
Politicians, health care policy wonks and vested interests
will brush aside the ACA’s adverse effects. You’ll hear that
some have fallen through the cracks of health care reform
but the problems can be easily tweaked. You will also
witness the usual dog-and-pony show on Capitol Hill in which
the two parties play the blame game. The bought-and-paid-for
mainstream media will regurgitate whatever Washington feeds
it, and TV talking heads will chime in, inviting their
“experts” to analyze the situation while real people in the
real world struggle to get by under this law or fall by the
wayside.

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